Acupuncture for cancer pain in adults.

BACKGROUND: Forty percent of individuals with early or intermediate stage cancer and 90% with advanced cancer have moderate to severe pain and up to 70% of patients with cancer pain do not receive adequate pain relief. It has been claimed that acupuncture has a role in management of cancer pain and guidelines exist for treatment of cancer pain with acupuncture. OBJECTIVES: To evaluate efficacy of acupuncture for relief of cancer-related pain in adults. SEARCH STRATEGY: CENTRAL, MEDLINE, EMBASE, PsycINFO, AMED, and SPORTDiscus were searched up to November 2010 including non-English language papers. SELECTION CRITERIA: Randomised controlled trials (RCTs) evaluating any type of invasive acupuncture for pain directly related to cancer in adults of 18 years or over. DATA COLLECTION AND ANALYSIS: It was planned to pool data to provide an overall measure of effect and to calculate the number needed to treat to benefit, but this was not possible due to heterogeneity. Two review authors (CP, OT) independently extracted data adding it to data extraction sheets. Quality scores were given to studies. Data sheets were compared and discussed with a third review author (MJ) who acted as arbiter. Data analysis was conducted by CP, OT and MJ. MAIN RESULTS: Three RCTs (204 participants) were included. One high quality study investigated the effect of auricular acupuncture compared with auricular acupuncture at 'placebo' points and with non-invasive vaccaria ear seeds attached at 'placebo' points. Participants in two acupuncture groups were blinded but blinding wasn't possible in the ear seeds group because seeds were attached using tape. This may have biased results in favour of acupuncture groups. Participants in the real acupuncture group had lower pain scores at two month follow-up than either the placebo or ear seeds group.There was high risk of bias in two studies because of low methodological quality. One study comparing acupuncture with medication concluded that both methods were effective in controlling pain, although acupuncture was the most effective. The second study compared acupuncture, point-injection and medication in participants with stomach cancer. Long-term pain relief was reported for both acupuncture and point-injection compared with medication during the last 10 days of treatment. Although both studies have positive results in favour of acupuncture they should be viewed with caution due to methodological limitations, small sample sizes, poor reporting and inadequate analysis. AUTHORS' CONCLUSIONS: There is insufficient evidence to judge whether acupuncture is effective in treating cancer pain in adults

Acupuncture randomized trials (ART) in patients with chronic low back pain and osteoarthritis of the knee - Design and protocols

Background: We report on the study design and protocols of two randomized controlled trials (Acupuncture Randomized Trials = ART) that investigate the efficacy of acupuncture in the treatment of chronic low back pain and osteoarthritis of the knee, respectively. Objective: To investigate whether acupuncture is more efficacious than (a) no treatment or (b) minimal acupuncture in the treatment of low back pain and osteoarthritis. Design: Two randomized, controlled, multicenter trials with three treatment arms and a total follow-up time of 52 weeks. Setting: 30 practitioners and outpatient units in Germany specialized in acupuncture treatment. Patients: 300 patients will be included in each study. In the low back pain trial, patients will be included according to clinical diagnosis. In the osteoarthritis pain trial, patients will be included according to the American College of Rheumatology criteria. Interventions: Patients are randomly assigned to receive either (1) semi-standardized acupuncture (150 patients), (2) minimal acupuncture at non-acupuncture points (75 patients), or (3) no treatment for two months followed by semi-standardized acupuncture (75 patients, waiting list control). Acupuncture treatment consists of 12 sessions per patient over a period of 8 weeks. Main Outcome Measure: The main outcome measure is the difference between baseline and the end of the 8-week treatment period in the following parameters: pain intensity as measured by a visual analogue scale (VAS; 0-100 mm) in the low back pain trial and by the Western Ontario and McMaster Universities Osteoarthritis Score (WOMAC) in the osteoarthritis trial. Outlook: The results of these two studies (available in 2004) will provide health care providers and policy makers with the information needed to make scientifically sound assessments of acupuncture therapy

Acupuncture Point Localization Varies Among Acupuncturists

Background: Studies assessing the point-specific effect of acupuncture or the characteristics of acupuncture points (APs) tend to yield inconclusive results. In order to identify a possible confounding factor, we aimed to examine the variability in AP localization by means of a survey. Material and Methods: Attendees of the 14th ICMART (International Council of Medical Acupuncture and Related Techniques) congress as well as DAGfA (German Medical Society of Acupuncture) lecturers and students were asked to locate and mark the APs LI 10 and TH 5 on a research assistant's arm. Identified points were transferred into a coordinate system, and the respective bivariate distribution function was calculated. Additionally, participants filled out a questionnaire about their acupuncture education and experience, the acupuncture style and point localization techniques used most frequently, and their estimation of the size of an AP. Results: The areas of the ellipses, theoretically containing 95% of AP localizations, varied between 44.49 and 5.18 cm(2). The largest distance between 2 identified points was 8.45 cm for LI 10 and 5.3 cm for TH 5. Apart from being trained at the same school, no other factor could be identified that determined the variability in AP localization. Conclusion: Our results indicate that congruity of AP localization among experienced acupuncturists might be low. Although there are some limitations to our results, this possible bias should be taken into account when conducting acupuncture trials and interpreting results of previous acupuncture studies

Acupuncture in Seasonal Allergic Rhinitis (ACUSAR) - Design and Protocol of a Randomised Controlled Multi-Centre Trial

Background: We report on the study design and protocol of a randomised controlled trial (Acupuncture in Seasonal Allergic Rhinitis, ACUSAR) that investigates the efficacy of acupuncture in the treatment of seasonal allergic rhinitis (SAR). Objective: To investigate whether acupuncture is non-inferior or superior to (a) penetrating sham acupuncture and (b) rescue medication in the treatment of SAR. Design: 3-armed, randomised controlled multi-centre trial with a total follow-up time of 16 weeks in the 1st year and 8 weeks in the 2nd year. Setting: 41 physicians in 37 out-patient units in Germany specialised in acupuncture treatment. Patients: 400 seasonal allergic rhinitis patients with clinical symptoms and test-positive (skin-prick test and/or specific IgE) to both birch and grass pollen. Interventions: Patients will be randomised in a 2:1:1 ratio to one of three groups: (a) semi-standardised acupuncture plus rescue medication (cetirizine); (b) penetrating sham acupuncture at non-acupuncture points plus rescue medication; or (c) rescue medication alone for 8 weeks (standard treatment group). Acupuncture and sham acupuncture will consist of 12 treatments per patient over 8 weeks. Main Outcome Measures: Average means of the Rhinitis Quality of Life Questionnaire (RQLQ) overall score and the Rescue Medication Score (RMS) between weeks 6 and 8 in the first year, adjusted for baseline values. Outlook: The results of this trial available in 2011 will have a major impact on the decision of whether acupuncture should be considered as a therapeutic option in the treatment of SAR

Differential cerebral response to somatosensory stimulation of an acupuncture point vs. two non-acupuncture points measured with EEG and fMRI

Acupuncture can be regarded as a complex somatosensory stimulation. Here, we evaluate whether the point locations chosen for a somatosensory stimulation with acupuncture needles differently change the brain activity in healthy volunteers. We used EEG, event-related fMRI, and resting-state functional connectivity fMRI to assess neural responses to standardized needle stimulation of the acupuncture point ST36 (lower leg) and two control point locations (CP1 same dermatome, CP2 different dermatome). Cerebral responses were expected to differ for stimulation in two different dermatomes (CP2 different from ST36 and CP1), or stimulation at the acupuncture point vs. the control points. For EEG, mu rhythm power increased for ST36 compared to CP1 or CP2, but not when comparing the two control points. The fMRI analysis found more pronounced insula and S2 (secondary somatosensory cortex) activation, as well as precuneus deactivation during ST36 stimulation. The S2 seed-based functional connectivity analysis revealed increased connectivity to right precuneus for both comparisons, ST36 vs. CP1 and ST36 vs. CP2, however in different regions. Our results suggest that stimulation at acupuncture points may modulate somatosensory and saliency processing regions more readily than stimulation at non-acupuncture point locations. Also, our findings suggest potential modulation of pain perception due to acupuncture stimulation

Status and strategies analysis on international standardization of auricular acupuncture points

AbstractObjectiveTo supply literature for developing an international standard of auricular acupuncture points.MethodsElectronic database searches were conducted in the Chinese National Knowledge Infrastructure and VIP, and the Western databases, Pubmed, the National Science and Technology Library, and the German Journal of Acupuncture, from 1990 to April, 2012. We also searched the documents of international symposiums for auricular acupuncture points (AAPs). Keywords were “auricular points”, “auricular acupuncture points”, “ear points”, or “auriculotherapy”.ResultsBasic and clinical research on AAPs was performed in China, the United States, France, and Germany. Clinical AAP research was done in Italy, Austria, Switzerland, Spain, the UK, Holland, Japan, Russia, and Africa. However, AAP research was not communicated internationally. The World Federation of Acupuncture-Moxibustion Societies recommended international standard of auricular acupuncture points (ISAAPs). Standardized nomenclature and locations of AAPs would provide a solid basis to draft an international standard organization.ConclusionExperts need to find common points from different countries or regions, provide evidence of different ideas, and list the proposal as a recommendation for an international standard

Use of functional MRI to evaluate correlation between acupoints and brain cortex activites: comparison between conventional and electrical acupuncture

The use of acupuncture therapy in various functional disorders goes back several thousand years in China. Recendy, acupuncture becomes a 'hot' topic in the functional Magnetic Resonance (MR) imaging research studies [1-4]. A majority of these research projects is to study die correlation between the acupuncture points (acupoints) and die corresponding brain cortices, either by conventional acupuncture, electro-acupuncture or laser acupuncture. Cho et al reported mat by stimulating die vision-related acupoints (BL60, BL65, BL66, BL67) at the lateral side of die foot, neural response (i.e. high signal) was obtained at die visual cortex [1]. In this study, we verified Cho et al acupoints using conventional acupuncture and electro-acupuncture.published_or_final_versio

Effect of acupuncture on the healing of benign vocal fold lesions

Acupuncture treatment has been an active field of research in Western Medicine for many years. This study aims to study the healing effect of acupuncture treatment on vocal fold lesions. Fifty-five subjects that were randomized into three groups, genuine, sham and control group underwent 12-weekly acupuncture treatments, and data from the assessment at pre-treatment, post-treatment and 1 month post-treatment were analyzed. The genuine group received acupuncture treatment on nine acupuncture points. The sham group received the same acupuncture treatment except with blunt needles. Five visual-perceptual judgment of stroboscopic parameters were used to measure the recovery of the vocal folds. Results were inconclusive in terms of whether acupuncture treatment was effective in healing the vocal folds.published_or_final_versionSpeech and Hearing SciencesBachelorBachelor of Science in Speech and Hearing Science

Stimulation of TRPV1 by green laser light

Low-level laser irradiation of visible light had been introduced as a medical treatment already more than 40 years ago, but its medical application still remains controversial. Laser stimulation of acupuncture points has also been introduced, and mast-cells degranulation has been suggested. Activation of TRPV ion channels may be involved in the degranulation. Here, we investigated whether TRPV1 could serve as candidate for laser-induced mast cell activation. Activation of TRPV1 by capsaicin resulted in degranulation. To investigate the effect of laser irradiation on TRPV1, we used the Xenopus oocyte as expression and model system. We show that TRPV1 can functionally be expressed in the oocyte by (a) activation by capsaicin (K 1/2 = 1.1 μM), (b) activation by temperatures exceeding 42°C, (c) activation by reduced pH (from 7.4 to 6.2), and (d) inhibition by ruthenium red. Red (637 nm) as well as blue (406 nm) light neither affected membrane currents in oocytes nor did it modulate capsaicin-induced current. In contrast, green laser light (532 nm) produced power-dependent activation of TRPV1. In conclusion, we could show that green light is effective at the cellular level to activate TRPV1. To which extend green light is of medical relevance needs further investigation

Hypertension Therapy Using Acupuncture and Herbals of Leds and Carrots

Background: Hypertension or high blood pressure is an increase in systolic blood pressure of more than 140 mmHg and diastolic blood pressure of more than 90 mmHg in two measurements with an interval of five minutes in rest or quiet state. Hypertension in Traditional Chinese Medicine (TCM) is categorized in Xuan Yuan (vertigo) and Tou Tong (headache). Purpose: To determine the effect of acupuncture therapy using Fengchi (GB20), Taichong (LR3), Hegu (LI4) points and 2 additional points, namely Xuehai (SP10) and Chize (LU5) and herbs therapy for celery (Apium graveolens L.) and carrots (Daucus carota L.) for people with hypertension. Methods: Treatment of hypertension with acupuncture and herbs therapy. Acupuncture therapy was carried out at Fengchi (GB20), Taichong (LR3), Hegu (LI4) points with the principle of liver fire sedation and Xuehai (SP10) and Chize (LU5) with the tonification principle. In herbs therapy, patients were given fresh celery (Apium graveolens L.) and carrots (Daucus carota L.) which had a hypotensive effect. Results: Hypertension treatment with acupuncture therapy was given 12 times, 3 times a week. Herbs therapy was given for 4 weeks, taken once a day in the afternoon with a dose of 200 ml. This therapy could reduce the patient's blood pressure. Conclusion: Acupuncture therapy in Fengchi (GB20), Taichong (LR3), Hegu (LI4) Xuehai (SP10), Chize (LU5) plus fresh celery herbs (Apium graveolens L.) and carrots (Daucus carota L.) could reduce blood pressure and additional complaints in hypertensive patient